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Zhou X, Zhang X, Zhou D, Zhao Y, Duan X. A Narrative Review of Ocular Surface Disease Related to Anti-Glaucomatous Medications. Ophthalmol Ther 2022; 11:1681-1704. [PMID: 35943668 PMCID: PMC9437175 DOI: 10.1007/s40123-022-00557-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/29/2022] [Indexed: 01/31/2023] Open
Abstract
Topical anti-glaucomatous medications are still the most important measure to lower intraocular pressure. Large number of studies have confirmed that long-term use of anti-glaucomatous eye drops, especially containing benzalkonium chloride, a preservative, can cause or aggravate ocular surface injury. Ocular surface diseases damage the ocular microenvironmental health status, reduce the patients’ compliance with the treatment, and finally affect the treatment result. Therefore, the ocular surface management of patients with glaucoma is very important. This includes the selection of drugs that are better tolerated according to individual conditions, preservative-free formulations, drugs that protect against ocular surface disease, or selecting surgery and laser treatment, to prevent the damage to the ocular surface by topical anti-glaucomatous drugs.
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Affiliation(s)
- Xiaoyu Zhou
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xinyue Zhang
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Dengming Zhou
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yang Zhao
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xuanchu Duan
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China.
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2
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Ringuet J, Lajoie C, Bourgault S, Simonyan D, Houle MC. The Benefit Of Scratch Patch Testing To Demonstrate Ocular Contact Allergy To Brimonidine Tartrate. Contact Dermatitis 2022; 87:336-342. [PMID: 35642327 DOI: 10.1111/cod.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ocular allergies to brimonidine are frequent in patients treated for glaucoma. There is variability in reporting due to the lack of diagnostic criteria and absence of cutaneous testing. Many false negative patch tests (PT) have been described. Alternative methods, such as strip and scratch PT, have been used without a standardized method. OBJECTIVES The primary objective is to identify the best method of cutaneous testing and brimonidine concentration for patch testing. The secondary objective is to identify clinical signs and symptoms suggestive of ocular allergy. PATIENTS AND METHODS A retrospective review of patient files suspected of brimonidine ocular allergy was performed. Patch testing method, brimonidine concentration and clinical symptoms were reviewed. RESULTS Of the 36 patients identified, half tested positive to brimonidine for at least one of the testing methods. The scratch PT demonstrated 17 positive reactions (94% detection rate). 3 patients reacted with strip PT. No positive results were found with standard PT. The 5% brimonidine concentration demonstrated the highest sensitivity. Absence of eyelid pruritus was associated with negative testing. CONCLUSION In the investigation of ocular allergy to brimonidine, scratch PT proved to be an essential tool. Brimonidine 5% pet. appeared as the most sensitive concentration for scratch PT.
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Affiliation(s)
- Julien Ringuet
- University Laval, Faculty of Medicine, Department of Dermatology, Québec, Canada.,Centre de Recherche Dermatologique du Québec Métropolitain (CRDQ), Québec, Québec, Canada
| | - Caroline Lajoie
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Québec, Québec, Canada.,Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Québec, Québec, Canada
| | - Serge Bourgault
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Québec, Québec, Canada.,Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Québec, Québec, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada
| | - Marie-Claude Houle
- Department of Medicine, Division of Dermatology, Hôtel-Dieu de Québec, Université Laval, Québec, Canada
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Yeh PH, Cheng YC, Shie SS, Lee YS, Shen SC, Chen HSL, Wu WC, Su WW. Brimonidine related acute follicular conjunctivitis: Onset time and clinical presentations, a long-term follow-up. Medicine (Baltimore) 2021; 100:e26724. [PMID: 34398046 PMCID: PMC8294862 DOI: 10.1097/md.0000000000026724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
Abstract
To evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy.We retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008 to November 30, 2020. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP, and season of onset were evaluated.292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60-120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy (P < .001), which was even higher in the brimonidine monotherapy group (9.2%, P < .001). There was no significant IOP elevation in patients treated with multiple glaucoma medications.Around half of brimonidine allergy occurred within 6 months, with a peak in 2 to 4 months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy. It is recommended to switch to other types of glaucoma medications for better IOP control.
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Affiliation(s)
- Po-Han Yeh
- Department of Ophthalmology, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chun Cheng
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shian-Sen Shie
- Department of Internal Medicine, Chang Gung Memorial Hospital Linkou
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Sung Lee
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Su-Chin Shen
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Henry Shen-Lih Chen
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Wen Su
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
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Park IK, Bae SH, Kim KW, Chun YS. Clinical Characteristics of Allergy to a Brinzolamide 1.0%/Brimonidine 0.2% Fixed Combination in Korean Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Corneal Opacity Induced by Antiglaucoma Agents Other Than Brimonidine Tartrate. Case Rep Ophthalmol Med 2020; 2020:4803651. [PMID: 32547800 PMCID: PMC7273428 DOI: 10.1155/2020/4803651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/18/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to report a patient with corneal opacity that developed after the use of topical antiglaucoma medications other than brimonidine tartrate (BT). An 85-year-old woman presented with corneal opacity and neovascularization in both eyes. A diagnosis of glaucoma was made 20 years previously, and antiglaucoma agents were prescribed (latanoprost, tafluprost, timolol maleate, travoprost, bimatoprost, ripasudil hydrochloride hydrate, and brinzolamide/timolol maleate) for both eyes. Ocular examination revealed semicircular fan-shaped corneal sterile infiltration with neovascularization. Anterior-segment optical coherence tomography (OCT) showed marked corneal opacity and thickened corneal stroma. The topical drugs were discontinued and replaced with 0.1% betamethasone eye drops. Two weeks after topical drugs were discontinued and replaced with betamethasone, the corneal sterile infiltration markedly improved, although the corneal opacity remained across the stromal layer. In addition, corneal opacity, intermixed with separate transparent sections, was observed as a striped shape. OCT showed an improvement of the thickened corneal stroma. Six weeks after the initial visit, the remaining corneal opacity could be seen as a mixture of opaque and nonopaque areas in stripes. The corneal stromal thickness decreased almost back to the normal range, while the area of the corneal opacity remained unchanged. In vivo laser confocal microscopy showed hyperreflective materials with needle-like structures in the corneal stroma. The corneal opacity showed several similarities to the previous reports of the cases treated with BT. Therefore, clinicians should be mindful of a possible development of corneal opacity in patients treated with antiglaucoma medications other than BT.
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Saito H, Kagami S, Mishima K, Mataki N, Fukushima A, Araie M. Long-term Side Effects Including Blepharitis Leading to Discontinuation of Ripasudil. J Glaucoma 2020; 28:289-293. [PMID: 30720574 DOI: 10.1097/ijg.0000000000001203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Blepharitis was the most common side effect leading to discontinuation of ripasudil therapy. Prior allergic reactions to other topical glaucoma were found to be a risk factor for ripasudil-induced blepharitis. PURPOSE To report the incidence proportion of blepharitis and its relating factors due to long-term use of 0.4% riapasudil, a Rho-kinase inhibitor, in glaucoma patients of a clinical setting. PATIENTS AND METHODS One hundred three eyes of 103 consecutive glaucoma patients who started ripasudil treatment between December 2014 and February 2017 at our institute, and who had a follow-up period of over 6 months were enrolled in this study. Incidence proportion, time required for recovery and risk factors associated with blepharitis and other side effects that led to discontinuation of ripasudil treatment were considered. RESULTS The most frequently observed side effect was blepharitis (25.2%). The 12- and 24-month discontinuation rate due to blepharitis was 21.1%±8.2% and 34.6%±11.8% (average±SE), respectively (Kaplan-Meier analysis). Most patients recovered from blepharitis symptoms within 4 weeks, but 5 patients required over 8 weeks for recovery. Past history of allergic reactions to other topical glaucoma medication was significantly correlated with the manifestation of blepharitis (Cox proportional hazard model, P<0.007) while age, sex, intraocular pressure reduction rate, number of administered eye drops, history of systemic allergic diseases were not. CONCLUSIONS Blepharitis was the most common reason for discontinuation of ripasudil treatment. Although most cases were resolved spontaneously, prolonged blepharitis was observed in a few patients. A past history of allergic reaction to other glaucoma medication indicates a higher possibility of blepharitis with ripasudil use and warrants careful administration.
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Affiliation(s)
| | - Shinji Kagami
- Dermatology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo
| | | | | | - Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi, Japan
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Rosenfeld E, Barequet D, Rabina G, Langier S, Lazar M, Shemesh G, Kurtz S, Kivity S. Effect of brimonidine tartrate on basophil activation in glaucoma patients. Int J Ophthalmol 2020; 13:509-512. [PMID: 32309191 DOI: 10.18240/ijo.2020.03.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the mechanism of which brimonidine tartrate 0.15% causes clinical hypersensitivity. METHODS A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers. Blood samples were stimulated with brimonidine 0.15%, timolol 0.5% or brimonidine tartrate/timolol maleate 0.2%/0.5%. Premixed antibodies (CD63/FITC and aIgE/PE) were added for direct staining and whole-blood samples were lysed, fixed and analyzed by a flow cytometer. The basophil population was defined by high IgE cell expression. Degranulation was identified by the expression of the activation molecule CD63. RESULTS Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine (2.58%, 2.45%, respectively, P=0.72). There was a significant suppression of basophil activation when a combination of brimonidine-timolol (0.87%) was compared to timolol (2.27%; P=0.012) and to brimonidine alone (2.58%; P=0.017). CONCLUSION The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction. Basophil activation was suppressed by the presence of β-blockers in patients hypersensitive to brimonidine and in healthy individuals. This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.
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Affiliation(s)
- Eldar Rosenfeld
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Dana Barequet
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Gilad Rabina
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Sheila Langier
- Department of Allergy and Immunology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Moshe Lazar
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Gabi Shemesh
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shimon Kurtz
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shmuel Kivity
- Department of Allergy and Immunology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Bielory L, Delgado L, Katelaris CH, Leonardi A, Rosario N, Vichyanoud P. ICON: Diagnosis and management of allergic conjunctivitis. Ann Allergy Asthma Immunol 2019; 124:118-134. [PMID: 31759180 DOI: 10.1016/j.anai.2019.11.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. Multiple, often co-existing causes are seen, and a broad differential diagnosis for OA, increasing the difficulty of arriving at the correct diagnosis(es). Ocular allergy commonly overlaps with other anterior ocular disease disorders, including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of underdiagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures, which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross-referral between specialists (allergists and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.
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Affiliation(s)
- Leonard Bielory
- Department of Medicine and Ophthalmology, Hackensack Meridian School of Medicine, Springfield, NJ 07081.
| | - Luis Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, and CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Constance H Katelaris
- Western Sydney University, Campbelltown Hospital, Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Andrea Leonardi
- Department of Neurosciences & Ophthalmology, University of Padua, Padua, Italy
| | - Nelson Rosario
- Division of Pediatric Allergy, Immunology and Pneumology, Hospital de Clinicas, UFPR Professor of Pediatrics Federal University of Parana, Curitiba, Brazil
| | - Pakit Vichyanoud
- Emeritus Faculty of Medicine, Pediatric Allergy and Immunology Chulalongkorn, University Bangkok, Thailand
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Tsujinaka A, Takai Y, Inoue Y, Tanito M. A case of bilateral deep stromal corneal opacity and vascularization after use of multiple antiglaucoma medications including brimonidine tartrate ophthalmic solution. Acta Ophthalmol 2019; 97:e948-e949. [PMID: 30609169 DOI: 10.1111/aos.14008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Aika Tsujinaka
- Department of Ophthalmology Faculty of Medicine Shimane University Izumo Japan
| | - Yasuyuki Takai
- Department of Ophthalmology Faculty of Medicine Shimane University Izumo Japan
| | - Yoshitsugu Inoue
- Division of Ophthalmology and Visual Science Faculty of Medicine Tottori University Yonago Japan
| | - Masaki Tanito
- Department of Ophthalmology Faculty of Medicine Shimane University Izumo Japan
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10
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Han J, Choi W, Lee WS, Bae HW, Kim CY, Seong GJ. The Relationship between Allergic Conjunctivitis due to Brimonidine and Systemic Allergic Disease in Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.3.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jongwook Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Wungrak Choi
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Lee
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Shinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Shinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kurysheva NI. [Selective α2-agonists in the treatment of glaucoma: pharmacology, efficacy and safety]. Vestn Oftalmol 2019; 135:144-150. [PMID: 31215546 DOI: 10.17116/oftalma2019135021144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Glaucoma is the main cause of irreversible blindness in the world. Among the hypotensive eye drops, an important place belongs to the selective α2-adrenergic receptor antagonist brimonidine. This part of the review focuses on key pharmacological and therapeutic characteristics of brimonidine and its mode of action. The article also discusses the side effects of brimonidine and the methods of their prevention.
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Affiliation(s)
- N I Kurysheva
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation State Research Center ,Burnasyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency, Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Department of Opthalmology, 15 Gamalei St., Moscow, Russian Federation, 123098
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Abstract
Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.
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Asiedu K, Abu SL. The impact of topical intraocular pressure lowering medications on the ocular surface of glaucoma patients: A review. J Curr Ophthalmol 2018; 31:8-15. [PMID: 30899840 PMCID: PMC6407091 DOI: 10.1016/j.joco.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/25/2018] [Accepted: 07/11/2018] [Indexed: 01/05/2023] Open
Abstract
Purpose To assess the literature on the effects of topical intraocular pressure (IOP)-lowering medications on the ocular surface. Ocular surface assessment in these patients is seldom a priority for most clinicians since the ultimate goal of management is to preserve vision. Methods A literature search of articles (English only) on the subject matter was conducted and their findings summarized. Results This review assesses the prevalence of dry eye symptoms in glaucoma patients on topical IOP-lowering medications. We extensively reviewed the effects of the preservatives and active ingredients in these medications on the ocular surface. In particular, the effects of benzalkonium chloride (BAK), a widely used preservative, on meibomian glands are explored. Also mentioned in this review is the association between duration of therapy and severity of dry eye symptoms. The role of the pH of medications in the development of ocular surface disease is also reviewed. Finally, we probed the occurrences of ocular allergic reactions with the use of topical IOP-lowering medications. Conclusions The preservatives and active agents in most topical glaucoma medications are implicated in the prevalence of ocular surface discomfort. Whilst clinicians involved in glaucoma care are encouraged to assess the ocular surface routinely, further studies are needed to demonstrate the contributions of other physiochemical properties of these medications to the development of ocular surface disease in these patients.
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Affiliation(s)
- Kofi Asiedu
- Eye Clinic, Twumasiwaa Medical Center ARS Junction East Legon, Accra, Ghana
- Corresponding author.
| | - Sampson Listowell Abu
- Department of Ophthalmology and Visual Science, University of Alabama, Birmingham, AL, USA
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Abstract
We report a case of a patient who developed a severe case of follicular conjunctivitis from brinzolamide after 1.5 years of consistent use. This patient was rechallenged again after resolution of the follicles and subsequently redeveloped similar conjunctivitis. This is the first confirmed reported case of follicular conjunctivitis from brinzolamide use.
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Ringuet J, Houle MC. Case Report: Allergic Contact Dermatitis to Topical Brimonidine Demonstrated With Patch Testing: Insights on Evaluation of Brimonidine Sensitization. J Cutan Med Surg 2018; 22:636-638. [DOI: 10.1177/1203475418789020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Julien Ringuet
- Faculty of Medicine, Department of Dermatology, Laval University, Québec, QC, Canada
| | - Marie-Claude Houle
- Department of Medicine, Division of Dermatology, Hôtel-Dieu de Québec, Laval University, Québec, QC, Canada
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16
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Di Zazzo A, Roberti G, Mashaghi A, Abud TB, Pavese D, Bonini S. Use of Topical Cannabinomimetic Palmitoylethanolamide in Ocular Surface Disease Associated with Antiglaucoma Medications. J Ocul Pharmacol Ther 2018; 33:670-677. [PMID: 29045169 DOI: 10.1089/jop.2016.0117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Chronic use of topical hypotensive therapies in glaucoma patients leads to chronic inflammation of the ocular surface, which decreases the success rate of long-term glaucoma management. The aim of this study is to evaluate the effect of topical palmitoylethanolamide (PEA) (Defluxa©), a well-known anti-inflammatory and analgesic agent, in suppressing the ocular surface inflammation associated with the use of hypotensive eye drops. METHODS In a pilot clinical trial, we enrolled 15 glaucomatous patients who received topical PEA (Defluxa) in addition to the current antiglaucoma drugs, while 15 glaucomatous patients did not receive any additional treatment. At 3 different time points (day 0, 15, and 30), signs of ocular surface involvement, adverse events, visual acuity, and intraocular pressure were assessed. RESULTS Topical PEA (Defluxa) was effective in increasing the Schirmer test (P < 0.05) and the tear film breakup time (T-BUT) (P < 0.0001), and improving the conjunctival hyperemia (P < 0.0001) by day 30, compared to baseline. Compared to control, by day 15, the conjunctival hyperemia score was significantly decreased in the PEA (Defluxa) group (P < 0.01), while the T-BUT and the Schirmer Test achieved a significant improvement by day 30 (P < 0.05; P < 0.01). DISCUSSION Our data suggests that topical PEA (Defluxa) is a safe, effective, and generally well-tolerated treatment to prevent or suppress ocular surface inflammation attributable to chronic glaucoma treatment.
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Affiliation(s)
| | | | - Alireza Mashaghi
- 2 Faculty of Mathematics and Natural Sciences, Leiden Academic Centre for Drug Research, Leiden University , Leiden, The Netherlands .,3 Schepens Eye Research Institute , Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.,4 Basir Eye Health Research Center , Tehran, Iran
| | - Tulio Batista Abud
- 5 Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Daniela Pavese
- 6 Department of Ophthalmology, Campus Bio-Medico University, Rome, Italy
| | - Stefano Bonini
- 6 Department of Ophthalmology, Campus Bio-Medico University, Rome, Italy
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Abstract
PURPOSE The primary side effects associated with 0.1% brimonidine tartrate (BT) ophthalmic solution with sodium chlorite are allergic conjunctivitis, blepharitis, and conjunctival hyperemia. However, cornea-related side effects are rare. In this study, we report 2 similar cases in which corneal neovascularization, corneal infiltration, and corneal opacity developed after BT eye-drop use. METHODS Retrospective report of 2 cases of corneal infiltration after BT eye-drop use. RESULTS Case 1 involved a 78-year-old woman with follicular conjunctivitis, corneal neovascularization, and infiltration in her left eye after unilateral instillation of BT eye drops in that eye. Case 2 involved a 75-year-old woman with bilateral corneal neovascularization and infiltration after instillation of BT eye drops. In both cases, the corneal complications were deemed to be side effects of BT, so those eye drops were replaced with 0.1% fluorometholone eye drops. After replacement, blepharitis and corneal neovascularization successfully resolved; however, a layer of opacity remained across the transparent layer of the cornea in both cases. CONCLUSIONS We encountered 2 cases of corneal and conjunctival complications that developed as side effects after BT eye-drop use, thus indicating that strict attention should be paid to the possibility of side effects after initiation of antiglaucoma eye-drop use.
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Abstract
Purpose. Ocular allergy induced by brimonidine tartrate 0.2% is a common adverse event that is associated with poor compliance and therefore treatment failure. The authors investigated the demographic and clinical characteristics associated with development of this allergy. Methods. In total, 133 patients with ocular hypertension or open angle glaucoma and treated with brimonidine tartrate 0.2% were retrospectively divided into two groups: allergic and nonallergic to brimonidine tartrate 0.2%. Demographic, local, and systemic ocular variables were compared in the two groups. Results. Altogether, 13.5% of patients (18 of 133) developed brimonidine ocular allergy, generally within 2 weeks of beginning treatment (mean time 14.8±17.9 days). Compared with the nonallergic group, the allergic group was significantly more likely to have a history of ocular allergy to eyedrops (p=0.048) and to topical beta blockers (p=0.019). Moreover, the allergic group showed decreased tear film production (p=0.044). Conclusions. Patients with a history of eyedrop allergy or with reduced tear film production are more likely to develop brimonidine-associated allergy. Brimonidine may therefore not be suitable for patients with a history of allergy.
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Affiliation(s)
- G. Manni
- Ophthalmology Department, University of Roma Tor Vergata, Roma - Italy
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Park EJ, Chun YS. Comparison of Allergy Prevalence between Brimonidine/Timolol Fixed Combination and 0.15% Brimonidine in Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eun Jung Park
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Allergic Contact Dermatitis to Ophthalmic Medications: Relevant Allergens and Alternative Testing Methods. Dermatitis 2016; 27:333-347. [DOI: 10.1097/der.0000000000000224] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Swanson LA, Warshaw EM. Allergic contact dermatitis to topical brimonidine tartrate gel 0.33% for treatment of rosacea. J Am Acad Dermatol 2014; 71:832-3. [DOI: 10.1016/j.jaad.2014.05.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 10/24/2022]
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Byrom L, Zappala T, Muir J. Dermatological reactions to ophthalmic preparations: More than meets the eye. Australas J Dermatol 2014; 55:95-8. [DOI: 10.1111/ajd.12152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/12/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa Byrom
- Department of Dermatology; Mater Hospital; Brisbane Australia
| | - Tania Zappala
- Department of Dermatology; Mater Childrens Hospital; Brisbane Australia
| | - Jim Muir
- Department of Dermatology; Mater Hospital and Belmont Specialist Centre; Brisbane Australia
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Bagnis A, Papadia M, Scotto R, Traverso CE. Antiglaucoma drugs: The role of preservative-free formulations. Saudi J Ophthalmol 2011; 25:389-94. [PMID: 23960953 DOI: 10.1016/j.sjopt.2011.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 08/18/2011] [Accepted: 08/24/2011] [Indexed: 11/18/2022] Open
Abstract
Hypersensitive reactions to eyedrops are a common finding in clinical practice and represent a frequent cause of discontinuation of the therapy. Moreover, experimental and clinical studies show that long term use of topical drugs may induce ocular surface changes causing discomfort and potentially negatively affecting the compliance to the treatment as well as the success rate of filtering procedures. The exact mechanism involved and the roles of the active compound and the preservatives in inducing such detrimental effects of ophthalmic solutions are unclear. During the last years several antiglaucoma agents have been marketed as either preservative-free or benzalkonium chloride-free formulations in an attempt to reduce the adverse effects related to preservatives. This paper summarizes the body of evidence from existing studies about preservatives in antiglaucoma eyedrops, focusing on the latest compounds commercially available. A systematic review of the literature was performed. Current research is focusing not only on the efficacy of the drugs but also on their tolerability. Based on the existing data, there is a rationale to support the use of benzalkonium-free solutions whenever possible, especially in patients suffering from concomitant ocular surface diseases, experiencing local side effects and in those expected to need multiple and prolonged topical treatments.
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Affiliation(s)
- Alessandro Bagnis
- Eye Clinic, Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy
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Arthur S, Cantor LB. Update on the role of alpha-agonists in glaucoma management. Exp Eye Res 2011; 93:271-83. [PMID: 21524649 DOI: 10.1016/j.exer.2011.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/03/2011] [Accepted: 04/04/2011] [Indexed: 11/19/2022]
Abstract
Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.
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Affiliation(s)
- Stella Arthur
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, 702 Rotary Circle, Indianapolis, IN 46202, USA
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Sullivan-Mee M, Pensyl D, Alldredge B, Halverson K, Gerhardt G, Qualls C. Brimonidine Hypersensitivity when Switching Between 0.2% and 0.15% Formulations. J Ocul Pharmacol Ther 2010; 26:355-60. [DOI: 10.1089/jop.2009.0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Sullivan-Mee
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | - Denise Pensyl
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | | | - Kathy Halverson
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | - Gretchen Gerhardt
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | - Clifford Qualls
- Department of Mathematics and Statistics, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Batiste CG, Myers J, Katz LJ. Brimonidine purite solution for open-angle glaucoma or ocular hypertension. EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.5.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Motolko MA. Comparison of allergy rates in glaucoma patients receiving brimonidine 0.2% monotherapy versus fixed-combination brimonidine 0.2%-timolol 0.5% therapy. Curr Med Res Opin 2008; 24:2663-7. [PMID: 18691444 DOI: 10.1185/03007990802333167] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the incidence of ocular allergy in glaucoma patients prospectively treated with 0.2% brimonidine-0.5% timolol fixed combination (Combigan) compared with the incidence of ocular allergy in patients treated with 0.2% brimonidine (Alphagan) monotherapy. STUDY DESIGN AND METHODS This was a comparative, non-randomized, single-site, interventional study involving patients with primary open-angle glaucoma or exfoliation syndrome who had not previously used brimonidine in any formulation and had no history of ocular allergy. In one study arm, 102 patients were prospectively treated with twice-daily 0.2% brimonidine-0.5% timolol fixed combination. In the other study arm, medical charts at the same center were reviewed to identify a control group of 102 patients who had been treated with twice-daily 0.2% brimonidine monotherapy. Follow-up was at 1, 3, 6, 9, 12, 15, and 18 months of treatment. MAIN OUTCOME MEASURE Ocular allergy defined as the presence of follicles and redness severe enough to warrant discontinuation of the medication. RESULTS The incidence of ocular allergy over 18 months of treatment was 8.8% (9/102) in the fixed-combination group compared with 17.6% (18/102) in the brimonidine group (p=0.097). Kaplan-Meier survival analysis suggested that ocular allergy may be reduced or delayed in patients treated with the brimonidine-timolol fixed combination (p=0.066). CONCLUSIONS The brimonidine-timolol fixed combination was associated with a 50% lower incidence in ocular allergy compared with 0.2% brimonidine monotherapy. This difference between treatments was not statistically significant (p=0.097) but is likely to be clinically important. Additional studies are needed to evaluate the incidence of ocular allergy associated with brimonidine-timolol fixed combination treatment.
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Affiliation(s)
- Michael A Motolko
- Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
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Katz LJ, Simmons ST, Craven ER. Efficacy and safety of brimonidine and dorzolamide for intraocular pressure lowering in glaucoma and ocular hypertension. Curr Med Res Opin 2007; 23:2971-83. [PMID: 17949534 DOI: 10.1185/030079907x242476] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Brimonidine and dorzolamide are intraocular pressure (IOP)-lowering medications most commonly used in second-line treatment of glaucoma and ocular hypertension. SCOPE An evidence-based review of comparative clinical trials of brimonidine and dorzolamide was undertaken to determine the relative efficacy and safety of these drugs in reducing IOP. Using the keywords 'brimonidine' and 'dorzolamide', all articles describing such trials from September 1966 to July 2007 were found in MEDLINE and EMBASE. FINDINGS In all identified studies, brimonidine and dorzolamide were both found to provide significant IOP reduction from treated or untreated baseline levels. Results of eight trials reported to date indicate that brimonidine produced either a lower treated IOP or greater pressure reduction from baseline than dorzolamide at one or more measured timepoints, and provided comparable IOP lowering over all other measurements. Differences between the IOP reductions provided by brimonidine and dorzolamide were more pronounced when the medications were used adjunctively with other classes of drugs. Six other trials showed similar efficacy, and one additional monotherapy study showed lower IOP with dorzolamide treatment. Ocular burning was noted with dorzolamide more than any other adverse event with either drug. Trials ranged widely in duration of therapy and the time of day IOP measurements were taken, and many were too small for sufficient statistical power. CONCLUSION Brimonidine and dorzolamide are both efficacious and reasonably well tolerated. Possible overall distinctions in efficacy were obscured by differences in study designs and treatment regimens, but adjunctive therapy with brimonidine may reduce IOP as effectively or more effectively than adjunctive or fixed combination dorzolamide therapy. In certain patients with glaucoma and ocular hypertension brimonidine may be a better choice than dorzolamide for second-line treatment.
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Affiliation(s)
- L Jay Katz
- Glaucoma, Wills Eye Hospital, Philadelphia, PA 19107, USA.
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Abstract
Several fixed combination products are now available in glaucoma management. Considerations when selecting combination therapy include safety, finding the best combination of mechanisms of action. Combigan® is one such product that has been shown to be more effective than either of its constituent agents, brimonidine or timolol, used alone. It has at least a similar intraocular pressure (IOP)-lowering effect as the concomitant use of its two constituents, and it produces a significant additional lowering of IOP in patients who switch from other therapies, including Cosopt®. Combigan has high patient satisfaction ratings.
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Hegde V, Robinson R, Dean F, Mulvihill HA, Ahluwalia H. Drug-Induced Ectropion. Ophthalmology 2007; 114:362-6. [PMID: 17270684 DOI: 10.1016/j.ophtha.2006.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2004] [Revised: 09/22/2006] [Accepted: 09/23/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To review cases of possible drug-induced ectropion and recommend what we consider to be best practice. DESIGN Retrospective observational case series. PARTICIPANTS Thirteen consecutive outpatients. METHODS Records of 13 outpatients on topical medication presenting with topical drug-induced ectropion were retrospectively analyzed. MAIN OUTCOME MEASURES Eyelid position, topical agent causing the allergy, and medical and surgical management options. RESULTS In all 13 patients, the ectropion resolved partially or completely after discontinuing the offending topical agent. Dorzolamide (53%) was the most common offending agent, followed by brimonidine (23%). One of the 13 patients underwent failed ectropion surgery correction before referral, but improved once the topical agent was discontinued. Two of the patients successfully underwent surgical correction for ectropion after discontinuing their topical therapy. Those patients who discontinued the topical therapy and had a short course of steroid therapy did not require surgical correction. CONCLUSIONS This study demonstrates that sensitivity to topical agents can induce ectropion in more than 1 manner. Chronic exposure to the causative agent leads to cicatricial changes in the anterior lamella of the eyelid in susceptible individuals, and can manifest as contact dermatitis leading to tissue edema and mechanical ectropion. Early recognition of this condition and discontinuation of therapy is of paramount importance; it may lead to complete resolution. Topical steroids are a necessary adjunct in the management of drug-induced ectropion. Based on our experience, we propose a management algorithm for drug-induced ectropion.
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Affiliation(s)
- Vijay Hegde
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom.
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Abstract
PURPOSE OF REVIEW To examine recently published papers dealing with drug-induced allergic reactions. As allergy is only one possible mechanism, this review was extended to all reports or studies describing allergic, inflammatory or toxic effects related to eyedrops since 2004. RECENT FINDINGS These studies were first classified into clinical reports or surveys, experimental works and biological studies showing drug-induced effects on the ocular surface or eyelids. Studies aimed at determining the role of preservatives or comparing preservative-free and preserved eyedrops were further analysed separately. SUMMARY Reports on allergic or toxic reactions of eyedrops are published repeatedly. The reports raising the most important issues are those concerning antiglaucoma drugs. They consistently describe inflammatory reactions at the conjunctival level, with strong evidence that preservative is a major source of toxicity for the ocular surface.
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Affiliation(s)
- Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, Paris, France.
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Randazzo A, Nizzola F, Rossetti L, Orzalesi N, Vinciguerra P. Pharmacological management of night vision disturbances after refractive surgery. J Cataract Refract Surg 2005; 31:1764-72. [PMID: 16246781 DOI: 10.1016/j.jcrs.2005.02.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of diluted aceclidine eyedrops in reducing night vision disturbances after refractive surgery. SETTING Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milano, Italy. METHODS This double-masked randomized clinical trial included 30 patients (60 eyes) with chronic night vision disturbance after refractive surgery. Patients were randomly allocated to receive (1) placebo, (2) aceclidine 0.016%, or (3) aceclidine 0.032%. Drugs were administered once or twice daily. Anterior segment, haze, uncorrected visual acuity, best corrected visual acuity, intraocular pressure, corneal maps, and scotopic pupil size were determined at baseline and at follow-up examinations (15 and 30 days after inclusion). Halos and double vision 4-step scales were built to determine subjective grading of night vision disturbance, and the root mean square (RMS) was calculated to determine objective changes in night vision disturbance. RESULTS The effect of diluted aceclidine started about 15 minutes after instillation and lasted for about 5 hours. No difference between the 2 dilutions could be found. Thirty-nine of 40 treated eyes showed a reduction in night vision disturbance. The mean reduction in halos and double vision grading was 1.42 +/- 0.5 (SD) and 1.14 +/- 0.4, respectively. A mean decrease in pupil size of 2.5 mm was measured. Thirty minutes after the instillation of diluted aceclidine, the topography-derived wavefront error showed a statistically significant reduction in RMS values (total, spherical, astigmatic, coma, and higher order), which was maintained for 5 hours. A transitory conjunctival hyperemia was the only side effect reported. CONCLUSION Diluted aceclidine seemed to be an effective and safe treatment for night vision disturbance following refractive surgery.
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Affiliation(s)
- Alessandro Randazzo
- Department of Ophthalmology, Istituto Clinico Humanita-Rozzano, Modena, Italy.
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